DCH/Navigant Medicaid & PeachCare Strategy Report

1. DCH/Navigant Medicaid & PeachCare Strategy Report Medical Association of Georgia February 4, 2012 Cam Grayson

2. Purpose of DCH Redesign • Formulate strategy for future of Medicaid and PeachCare for Kids • Comprehensive assessment of programs to identify redesign options Building a Better State of Health Since 1849

3. DCH Redesign Goals Enhance appropriate use of services by members Achieve long-term sustainable savings in services Improve health care outcomes for members Building a Better State of Health Since 1849

4. DCH Redesign Strategies • Gain administrative efficiencies • Ensure timely and appropriate access • Ensure operational feasibility • Align reimbursement with patient outcomes, quality • Encourage members to be accountable for own health • Develop a scalable solution Building a Better State of Health Since 1849

5. Approach/Content Project goals Study methodology and limitations National environmental scan Georgia-specific scan Options for Georgia’s design strategy Appendices Building a Better State of Health Since 1849

6. Evaluating the Options Phase I: Evaluate generic delivery system options Phase II: Assess potential services and populations to “carve in” or “carve out” Phase III: Develop and evaluate Georgia-specific delivery system option Phase IV: Identify recommendations Building a Better State of Health Since 1849

7. Delivery Systems Source: Navigant Medicaid and PeachCare for Kids Design Strategy Report, January 17, 2012, page 3-19 Building a Better State of Health Since 1849

8. Generic Delivery Systems Selected Option 6: Georgia Families Plus Option 8: “Commercial Style” Managed Care Option 9: Free Market Health Insurance Purchasing Building a Better State of Health Since 1849

9. Navigant “Carve Ins” (Population-Based) Behavioral health services Long-term care services Home and community-based waivers Dually eligible for Medicaid and Medicare Foster care children Building a Better State of Health Since 1849

10. Navigant “Carve Ins” (Service-Based) Behavioral health services LTC services Home and community-based waiver Dental services Transportation services Pharmacy services Building a Better State of Health Since 1849

11. Rationale for “Carve-Ins” Populations lack care management Streamlines single delivery system Clinical information linkages Limits patient confusion by one entity Cost efficiencies and improves quality Reduces administrative oversight Building a Better State of Health Since 1849

12. Rationale for “Carve-Ins” Vendors can leverage with providers to enforce coordination of care and outcomes using PFP and value-based purchasing One blended/capitated rate for all services under one contract stops “dumping” Building a Better State of Health Since 1849

13. Permutations to Generic Delivery System Option 1: Georgia Families Plus Option 2: Georgia Families Plus transitioning to “commercial style” managed care program Option 3: Georgia Families Plus transitioning to “commercial style” managed care program using ACOs and PCMHs Option 4: Georgia Families Plus and free market health insurance purchasing Building a Better State of Health Since 1849

14. Underlying Assumptions Delivery system can be implemented and applied to all populations on statewide basis DCH can introduce on incremental basis, beginning with traditionally managed populations and adding more complex populations in future Building a Better State of Health Since 1849

15. Recommended Delivery Systems Georgia Families Plus transitioning to “commercial style” managed care program that require ACOs and PCMHs Georgia Families Plus transitioning to “commercial style” managed care program Georgia Families Plus Building a Better State of Health Since 1849

16. Option 1: Georgia Families Plus Enrolls all populations (foster care, dual eligibles, ABD) and all services Uses value-based purchasing, performance measures Uses medical homes Obtains compliance using patient incentives Focuses on health and wellness Offers risk-based budget predictability Building a Better State of Health Since 1849

17. Option 2: Georgia Families Plus/Commercial Option 1 plus commercial managed care levers Many enrolled in commercial managed care Uses copayments, deductibles, HRAs, incentive payments, and prizes Initially excludes foster care, ABD, dual-eligible Building a Better State of Health Since 1849

18. Option 3: Georgia Families Plus/Commercial + Managed Care/ACOs/PCMHs Enroll many in commercial-style managed care Similar to former plan but requires ACOs and PCMHs Foster care, ABD, and dual-eligible not initially targeted Risk-based managed care Building a Better State of Health Since 1849

19. Option 4: Georgia Families Plus + Free Market Health Insurance Purchasing Implements Georgia Families Plus for children, foster care, ABD Free market health insurance purchasing program Allows patient choice of plans Maximizes budget predictability Building a Better State of Health Since 1849

20. Free Market Approach DCH defines standard benefit package Insurers would offer standard benefit package and health rewards account Insurers would seek certification from state and limit participation to less than six insurers DCH would not contract directly with health plans and would not process claims Medicaid members given a credit to purchase Building a Better State of Health Since 1849

21. Next Steps for DCH Select delivery system and “carve-in” populations and services Improve DCH internal operational issues such as credentialing, eligibility system, CMO contract monitoring Consider and decide on redesign Building a Better State of Health Since 1849

22. Key Design Options Delivery system leverages HRAs, HSAs Care and disease management Medication therapy management Contracted vendors Special populations Payment strategies Penalties and rewards Building a Better State of Health Since 1849

23. Implementation and Operational Needs Federal approvals Determining basis for populations/timelines DCH needs to change its organizational structure Determine what other information systems and operational changes are necessary Building a Better State of Health Since 1849

24. Planning for Key Design and Program Features Develop high-level implementation timeframe Convene team to develop recommendations for detailed program Convene advisory groups as needed Vet program design with stakeholders Develop strategies to mitigate risks Develop implementation plan and timeline Building a Better State of Health Since 1849

25. Questions? Cam Grayson cgrayson@mag.org 678.303.9275 Building a Better State of Health Since 1849